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Title: An evaluation of aetiology, patho-physiology and alternative treatment modalities for haemorrhoids and, reporting the results of a randomised controlled trial
Author: Shanmugam, Venkatesh
ISNI:       0000 0004 2682 6038
Awarding Body: University of Aberdeen
Current Institution: University of Aberdeen
Date of Award: 2008
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As part of the background literature search for this thesis a systematic review comparing rubber band ligation (RBL) and excisional surgery was undertaken. Excisional haemorrhoidectomy (EH) was demonstrated to be more effective in treating grade III haemorrhoids. This greater effectiveness appears to be achieved at the expense of an increased risk of procedure-related potential complications, including haemorrhage, prolonged post-operative pain, extended time off work, anal stenosis and disturbance of continence. No significant difference was seen in the efficacy of the two procedures in the treatment of grade II haemorrhoids. A variety of studies have proved the efficacy and safety of stapled haemorrhoidopexy (SH) compared with other treatment modalities (RBL, EH). Most published comparative trials of SH have evaluated the new procedure against EH. The fundamental difference in the mechanism of action of these two procedures limits the validity of such a comparison. In view of the reported relatively high recurrence rate for symptoms following RBL a procedure frequently adopted for grade II haemorrhoids and the lack of comparative studies against SH, a study was conducted in the form of a randomized controlled trial to compare these two techniques. This thesis is based on the results of this randomised controlled trial which aimed to evaluate the utility of SH, with respect to objective and subjective symptom control, compared to rubber band ligation for grade II circumferential symptomatic haemorrhoids. The relevant introductory topics on ambryology, anatomy and physiology of the ano-rectum will be discussed along side the aetiology, pathophysiology, clinical features and various treatment options for haemorrhoids. The results of the systematic review comparing RBL with surgical haemorrhoidectomy carried out during the same period has been added to this thesis in order to comprehensively cover the comparison of RBL with commonly practiced surgical treatment for haemorrhoidal disease.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Hemorrhoids